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Abstract Background Chronic ankle instability (CAI) often requires surgical intervention, but the optimal suturing repair technique remains unclear. This study aimed to compare the clinical efficacy of modified trans augmentation (MTA) suturing repair and trans augmentation (TA) suturing repair to provide a feasible option for patients with CAI and their surgeons. Methods This single-center retrospective study included 73 patients with CAI who treated between February 2019 and January 2021. Patients were assigned to MTA or TA groups based on ligament condition. Clinical outcomes were assessed using the American Orthopedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), anterior drawer test, patient satisfaction, and postoperative complications. Results Postoperative AOFAS scores were significantly higher in the MTA group (91.0 ± 7.1) compared to the TA group (83.3 ± 9.4, P

Graph neural networks (GNNs) have been effectively implemented in a variety of real-world applications, although their underlying work mechanisms remain a mystery. To unveil this mystery and advocate for trustworthy decision-making, many GNN explainers have been proposed. However, existing explainers often face significant challenges, such as the following: (1) explanations being tied to specific instances; (2) limited generalisability to unseen graphs; (3) potential generation of invalid graph structures; and (4) restrictions to particular tasks (e.g., node classification, graph classification). To address these challenges, we propose a novel explainer, GAN-GNNExplainer, which employs a generator to produce explanations and a discriminator to oversee the generation process, enhancing the reliability of the outputs. Despite its advantages, GAN-GNNExplainer still struggles with generating faithful explanations and underperforms on real-world datasets. To overcome these shortcomings, we introduce ACGAN-GNNExplainer, an approach that improves upon GAN-GNNExplainer by using a more robust discriminator that consistently monitors the generation process, thereby producing explanations that are both reliable and faithful. Extensive experiments on both synthetic and real-world graph datasets demonstrate the superiority of our proposed methods over existing GNN explainers.

Abstract Wastewater produced in beryllium mining seriously affects ecological balance and causes great environmental pressure. We designed a novel porous lotus leaf biochar modified with PO4 3−/NH4 + multifunctional groups (MLLB) and used it for beryllium(Be) removal from beryllium mining wastewater. Kinetic and thermodynamic experiments showed that the adsorption capacity (Qe) of Be with MLLB from the simulated beryllium mining wastewater could reach 40.38 g kg−1 (35 °C, pH = 5.5), and the adsorption process was spontaneous and endothermic. The dispersion coefficient Kd of Be with MLLB was 2.6 × 104 mL g−1, which proved that MLLB had strong selective adsorption capacity for Be. Phosphoric acid, ammonia, and hydroxyl groups on the MLLB surface would complex with Be to form Be(OH)2 and Be(NH4)PO4 complexation products, which implied that surface complexation and precipitation reactions might co-existed in the adsorption process. The above results showed that MLLB could effectively adsorb Be and prevent beryllium exposure in a beryllium mining process. Graphical Abstract

Abstract In the context of the dual carbon goal strategy, the proportion of new energy generation has increased annually, large‐scale renewable energy integration has been achieved, and the intermittent and uncertain operating characteristics pose an enormous challenge to the complete and stable operation of an integrated energy system (IES), promoting the complexity of IES optimization models. To increase the stability and accuracy of the system and improve the operation efficiency of the system, a Gaussian mixture model is used to fit the probability distribution of wind power and the prediction errors of the photovoltaic output. In addition, the expected maximization method is used to solve a model with hidden variables, the results show that the expectation maximization algorithm can improve the fitting accuracy, reduce the error caused by the subjective setting of the initial value, and make the fitting accuracy of the wind‐solar power prediction error greater. Then, to solve the problem in which the low resolution of the day‐ahead scheduling time leads to large errors, day‐ahead, day‐to‐day multitime scale operation optimization model takes into account the comprehensive demand response according to the differences in wind and solar output and load forecasting accuracy. Finally, simulation validation is conducted in multiple scenarios, and a comparative analysis is performed for single and multitime scale comprehensive demand response scenarios. The simulation results show that compared with the optimization results of no demand response day, the optimization results of this model reduce the total cost by 23.21%, carbon emissions by 13.98%, purchased electricity by 13.87%, and purchased gas by 19.31%, effectively improving the use of gas turbines in the system. The multitime scale scheduling strategy increases the overall operating cost of the IES, modifies the scheduling results, and agrees with real operating scenarios.

As the marine industry progresses, copper-containing metallic materials that possess both high strength and ductility are demanding. Traditional copper alloys used in marine environment face challenges regarding inadequate strength and corrosion resistance. In the present work, cold rolling and subsequent high-temperature annealing processes were employed to the Cu1.2NiMnFe0.5Cr0.5Al0.2 high-entropy alloy. This alloy exhibited remarkable mechanical properties, including a yield strength (YS) of 530 MPa, ultimate tensile strength (UTS) of 913 MPa, and a relatively high fracture elongation (EL) of 37.7%. After subsequent aging treatment at 400 °C, spinodal decomposition occurred within the matrix, leading to enhanced strength. The decomposed microstructure was comprehensively characterized, and the strengthening mechanism was analyzed. Notably, the sample aged for 6 h exhibited a YS of 701 MPa and an EL of 21.8%. The present HEAs exhibit superior mechanical properties compared to traditional copper alloys and other Cu-containing HEAs, when considering both strength and ductility. Furthermore, these alloys demonstrated exceptional corrosion resistance and a favorable copper ion release rate in 3.5 wt% NaCl solution. This work introduces an innovative class of advanced alloys and offers a strategic approach to alloy design for marine applications.

Background: In patients with papillary thyroid cancer (PTC) with clinical negative central lymph nodes (cN0), the use of prophylactic central lymph node dissection remains controversial. Contralateral central lymph node metastasis (CCLNM) occurs in 3.88–30.63% of patients with cN0 PTC. Therefore, the present meta-analysis aimed to obtain evidence for CCLNM risk factors in unilateral cN0 PTC. Materials and methods: Relevant studies were identified in the PubMed, SCIE, and Wanfang databases up to Oct 31, 2019. The included patients had undergone lobectomy or total thyroidectomy with bilateral central lymph node dissection and were diagnosed pathologically with PTC. Revman 5.3 software was applied for statistical analysis. Results: Thirteen studies comprising 2449 patients were included. The factors associated with increased CCLNM risk in patients with cN0 disease were: age

BackgroundBilateral lesions are common in papillary thyroid carcinoma (PTC). For patients with unilateral PTC, occult carcinoma that is not detected preoperatively, but pathologically after surgery, might remain in the contralateral lobe. In this situation, inadequate surgical extent could cause relapse and even lead to re-operation. Here, we explore the frequency and investigate the risk factors of contralateral occult PTC in unilateral PTC through a retrospective study conducted by our team and published articles online, respectively.MethodsWe collected the patients’ clinical data in our hospital, whose cancer was determined to be confined to the unilateral lobe by preoperative image examination (N = 204). These patients underwent initially total or near-total thyroidectomy and included their clinical data in the meta-analysis. We searched related literature in the PubMed, Embase, MEDLINE, Cochrane, and Web of Science databases until December 7, 2020, in order to perform a meta-analysis. The relevant articles were examined and the eligible studies were included to assess the association between clinicopathologic factors and contralateral occult PTC.ResultsThe meta-analysis included nine studies (involving 4347 patients). Of these, eight studies were from the databases, and one study was our retrospective data. The meta-analysis showed that the prevalence of contralateral occult PTC was 26.6% in all patients. A tumor size > 1 cm, ipsilateral multifocality, contralateral benign nodule, and central lymph node metastasis were significantly associated with contralateral occult PTC. In contrast, sex, age, ETE, capsular invasion, BRAF mutation, Hashimoto thyroiditis, and lateral lymph node metastasis were insignificantly associated with contralateral occult PTC.ConclusionThe meta-analysis identified a tumor size > 1 cm, ipsilateral multifocality, contralateral benign nodule, and CLNM as being significant risk factors for contralateral occult PTC. These findings may guide the extent of surgery in unilateral PTC patients.

Objective: This systematic review aimed to discuss the effects of a zero-markup policy for essential drugs (ZPED) on healthcare costs and utilization in China in the years 2015–2021.Methods: We searched the PubMed, Embase, Scopus, and CINAHL databases for all associated studies carried out from January 1, 2015, to May 31, 2021, without any limitations regarding the language the studies were written in. To prevent selection bias, gray documents were tackled by other means. The methodological approaches were assessed by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Newcastle-Ottawa Scale (NOS) collaboration tool.Results: Forty studies were selected at first and then 15 studies that met the inclusion criterion. Most of the studies showed a considerable decrease in total medical spending and drug spending in both outpatient and inpatient services. After the implementation of ZPED, studies showed that the medical services increased and total hospital income sustained, despite a decrease in drug revenue. Minimal or no government subsidy is required from a financial perspective.Conclusions: Although, the government could implement ZEPD with lower medical cost and drug cost to patients, and sustained income for health facilities, we have limited understanding of whether the increase in medical services was induced by the provider or was a response to unmet needs in the population. Further, studies using rigorous and advanced methods to study health policy, patient behaviors, provider behaviors, and government decisions are warranted.

In this study, our attention is focused on deriving integrals of motion (conservation laws; invariants) for the problem of an optical pulse propagation in an optical fiber containing an optical amplifier or attenuator because, to date, such invariants are absent in the literature. The knowledge of a problem’s invariants allows us develop finite-difference schemes possessing the conservativeness property, which is crucial for solving nonlinear problems. Laser pulse propagation is governed by the nonlinear Ginzburg–Landau equation. Firstly, the problem’s conservation laws are developed for the various parameters’ relations: for a linear case, for a nonlinear case without considering the linear absorption, and for a nonlinear case accounting for the linear absorption and homogeneous shift of the pulse’s phase. Hereafter, the Crank–Nicolson-type scheme is constructed for the problem difference approximation. To demonstrate the conservativeness of the constructed implicit finite-difference scheme in the sense of preserving difference analogs of the problem’s invariants, the corresponding theorems are formulated and proved. The problem of the finite-difference scheme’s nonlinearity is solved by means of an iterative process. Finally, several numerical examples are presented to support the theoretical results.

Post-cardiac arrest myocardial dysfunction significantly contributes to early mortality after the return of spontaneous circulation. However, no effective therapy is available now. Aldehyde dehydrogenase 2 (ALDH2) enzyme has been shown to protect the heart from aldehyde toxicity such as 4-hydroxy-2-nonenal (4-HNE) and oxidative stress. In this study, we evaluated the effect of enhanced activity or expression of ALDH2 on post-cardiac arrest myocardial dysfunction and survival in a rat cardiac arrest model. Furthermore, we elucidated the underlying mechanisms with a focus on mitochondrial reactive oxygen species (ROS) production in a cell hypoxia/reoxygenation model. A total of 126 rats were used for the ALDH2 activation or cardiac overexpression of ALDH2 studies. Randomization was done 10 min before the respective agonist injection or in vivo gene delivery. We showed that enhanced activity or expression of ALDH2 significantly improved contractile function of the left ventricle and survival rate in rats subjected to cardiac arrest-cardiopulmonary resuscitation procedure. Moreover, ALDH2 prevented cardiac arrest-induced cardiomyocyte death from apoptosis and mitochondrial damage. Mechanistically, 4-HNE, a representative substrate of ALDH2, was dominantly increased in the hypoxia/reoxygenation-exposed cardiomyocytes. Direct addition of 4-HNE led to significantly augmented succinate accumulation and mitochondrial ROS production. Through metabolizing 4-HNE, ALDH2 significantly inhibited mitochondrial ROS production. Our findings provide compelling evidence of the cardioprotective effects of ALDH2 and therapeutic targeting this enzyme would provide an important approach for treating post-cardiac arrest myocardial dysfunction.

It is generally difficult to obtain accurate optimisation functions during parameters matching and optimisation process of the hybrid system, especially in the optimisation variable field containing both a continuous set and a discontinuous set and when the control strategy has an important influence on the system performance. To aim at the fuel economy of the parallel hydraulic hybrid system, a global parameter matching and control strategy based on the simulation model were proposed. The AMESim simulation model as the judgment module of the optimisation algorithm was used to match and optimise the main parameters and control strategies in the hybrid system. The communication of underlying parameters was developed by the VBA in EXCEL platform. Parameters match was implemented on a truck crane chassis in practice. The test results indicated that the rate of fuel saving reached 15.2%, which was generally consistent with the theoretical analysis. The parameters were met the energy-saving requirements of hybrid vehicles.